Tuberculosis Trouble in Texas: Something Just Doesn’t Add Up

An employee working at a hospital in Texas may have exposed over 900 people totuberculosis (TB).

The employee worked in the nursery unit at Providence Memorial Hospital in El Paso. Infants born at the hospital between September 2013 and August 2014 could be infected with the bacterium.

It is estimated that, as of the time of this writing, 858 babies and 43 employees were exposed.

Of course, that number could (and probably will) change.

Sometime in August of this year, the unnamed female employee tested positive for TB.

Details on relevant dates are sketchy: some sources say the worker started showing symptoms of TB as long ago as December 2013. Some say July 2014. The exact date of her positive test result is also unknown: some sources say it was August 18, some say August 25, and others say August 27.

The employee was placed on leave and the hospital sent letters to parents of children born at the facility to notify them of the active (infectious) case and to offer free TB tests – and treatment if necessary.

From the letter:

TB is a serious but treatable disease that is spread through the air. Although TB is not easy to catch from another person, we want to be extra sure that your child is examined.

To check your child for the infection, we need to do a TB skin test, which is a common way to help tell if there are TB germs in the body. Your child should receive this TB skin test as soon as possible in order to determine if he or she has the TB germ. A nurse will look at the arm in 2-3 days to read the test. Your child will also need a chest x-ray so that a doctor can check to see if your child’s lungs are clear. A doctor will examine your child and answer any questions you may have. If it is needed, medication will be provided to further protect your child.

All these services will be provided for free by the Health Department or Providence Memorial Hospital.

Please note that a person who is exposed to TB is not able to spread the bacteria to other people right away. Only a person with active TB can spread TB germs to others.

As of September 27, five babies have tested positive for TB, according to the El Paso Department of Public Health.

Five babies have tested positive for Tuberculosis infection. These results are based on skin testing; all X-rays were negative. It is important to point out that they are not considered to have active TB disease. Four of these babies received a BCG (Bacillus Calmette-Guerin) vaccine that may be generating false positives, but all will be offered treatment.

Wait, what?

Four of the babies were given a vaccine PRIOR to testing (which isn’t contraindicated, but doesn’t seem to make sense), and are now being treated…even though the positive results could be false positives.

Let’s review some facts about the BCG vaccine and when it is recommended:

Infants under two months old can receive the BCG vaccine without being tested first.

BCG vaccination should only be considered for children who have a negative tuberculin skin test and who are continually exposed, and cannot be separated from, adults who are untreated or ineffectively treated for TB disease (if the child cannot be given long-term treatment for infection).

BCG vaccination may cause a false-positive reaction to the TST, which may complicate decisions about prescribing treatment.

Blood tests to detect TB infection, unlike the TST, are not affected by prior BCG vaccination and are less likely to give a false-positive result. These tests are generally recommended in children over the age of five because the skin test is more effective (UNLESS one is vaccinated first).

A reactive (positive) tuberculin skin test is a contraindication to BCG. Someone with a positive tuberculin reaction is not given BCG, because the risk of severe local inflammation and scarring is high.

So, here we have four babies who were given a TB vaccine (that has about a 50% chance of protecting them) PRIOR to being tested for TB in the first place. Their results were positive (go figure) and now they are being treated for TB, with a drug that has to be given daily for six to nine months.